Abstract
Background: Candida infection rate has been increasing significantly and the emergence of antifungal resistance among Candida species has also been seen over the past few decades due to the usage of empiric therapy for treating fungal infection. Moreover, new species of Candida which is multidrug resistant have been identified which prompted the correct detection of resistant isolates in order to avoid inappropriate treatment. The aim of this study is to determine the current epidemiology of Candida species among sterile clinical isolates in University Malaya Medical Centre and the susceptibility pattern of these isolates to antifungal agents. Methods and materials: Candida species isolated from sterile body fluids from 145 patients in University Malaya Medical Centre from July 2017 to December 2018 were identified using VITEK® 2 compact automated system with VITEK® 2 card (ID-YST card) and VITEK® MS (MALDI-TOFF MS). The antifungal susceptibilities were determined by VITEK® 2 fungal susceptibility card (AST-YS07 & AST-YS08 kit). Results: A total of 56 (36.1%) isolates of Candida albicans, 44 (28.4%) Candida tropicalis, 22 (14.2%) Candida parapsilosis, 14 (9.0%) Candida glabrata, 5 (3.2%) Candida dubliniensis, 4 (2.6%) Candida auris, 3 (1.9%) Candida krusei, 3 (1.9%) Candida orthopsilosis, 1 (0.6%) Candida duobushaemulonii, 1 (0.6%) Candida haemulonii, 1 (0.6%) Candida famata and 1(0.6%) Candida lusitaniae were isolated. Out of the 155 isolates, antifungal susceptibility was done in 117 isolates. Most of the isolates were sensitive to fluconazole 88 (77%), and 29 (23%) were resistant which were (3 isolates) C. albicans, (6 isolates) C. tropicalis, (1 isolate) C. parapsilosis, (1 isolate) C. glabrata and 8 others were SDD. Intermediate susceptibility towards amphotericin B, caspofungin and voriconazole were seen in 1.7%, 1.8% and 1% of cases respectively. 3(2.72%) isolates were noted to be resistant to voriconazole. All of the isolates that were tested were sensitive to micafungin. Conclusion: Candida albicans remains the most common species isolated. High rate of resistance towards fluconazole has been seen, which prompt usage of echinocandins as empirical treatment for Candida infections. Identification and susceptibility profile for each Candida species isolated from sterile clinical specimens are crucial to help guide the clinicians in patients’ management.
Published Version
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